Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer

Toriumi, Tetsuro; Makuuchi, Rie; Kamiya, Satoshi; Takeda, Yutaka; Bando, Etsuro; Terashima, Masanori

doi:10.1007/s00464-019-06787-x

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…By PSM, we found that low BMI and distal gastrectomy are independent risk factors for Petersen's hernia, which is consistent with a previous study by Han et al (11). In contrast, Toriumi et al (12) reported that high BMI is a risk factor for internal hernia after minimally invasive gastrectomy. We assumed that low BMI indicates low weight and less adipose tissue including less visceral fat that is theoretically associated with larger Petersen space.…”

Section: Discussionmentioning

confidence: 92%

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Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

Liu

Song

et al. 2021

Front. Oncol.

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BackgroundPetersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions.MethodsData from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation.ResultsA total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p < 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041).ConclusionsLow BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.

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Section: Discussionmentioning

confidence: 92%

“…In contrast, Toriumi et al. ( 12 ) reported that high BMI is a risk factor for internal hernia after minimally invasive gastrectomy. We assumed that low BMI indicates low weight and less adipose tissue including less visceral fat that is theoretically associated with larger Petersen space.…”

Section: Discussionmentioning

confidence: 94%

Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

Liu

Song

et al. 2021

Front. Oncol.

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“…Both surgeons participating in the study were very well experienced with gastrectomy and far beyond their learning curve for this operation, but this was not necessarily the case for PD closure. Therefore, the reason for this case of PH may be incomplete closure of the PD during primary surgery [26]. Another explanation is that defects may open after the loss of mesenteric fat, leading to the formation of PH [27].…”

Section: Discussionmentioning

confidence: 99%

Closure of Petersen’s defect in gastrectomy for gastric cancer: an interrupted time series analysis from a high-volume institution in China

Wang

Liu

Chen

et al. 2020

Langenbecks Arch Surg

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Purpose Petersen’s hernia (PH) is a serious complication after gastrectomy for gastric cancer. The aim of this study was to investigate whether closure of Petersen’s defect (PD) can decrease the rates of PH and suspected Petersen’s hernia (SPH). Methods Patients who underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without PD closure (non-closure group). From February 2017 to June 2018, we closed PDs during gastrectomy (closure group). The rates of PH and SPH were compared between the two groups. The last follow-up was updated in August 2020. Results Among a total of 1213 patients, 12 patients (1.0%) developed PH, and 23 patients (1.9%) developed SPH. The rate of PH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 11/828, 1.3%, p = 0.042, log-rank test). The rate of SPH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 22/828, 2.7%, p = 0.008, log-rank test). Non-closure of PD was a risk factor for PH and SPH (odds ratio (OR) 7.72, 95% CI 1.84–32.35, p = 0.006). Conclusions PD closure is recommended after gastrectomy for gastric cancer, as the rates of PH and SPH were significantly decreased.

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“…Both surgeons participating in the study were very well experienced with gastrectomy and far beyond their learning curve for this operation, but this was not necessarily the case for PD closure. Therefore, the reason for this may be incomplete closure of the PD during primary surgery 25 .Another explanation is that defects may open out after the loss of mesenteric fat, leading to the formation of IH 26 . Therefore, although closure of all mesenteric defects cannot completely prevent IH, current studies have shown that it may decrease the rate.…”

Section: Discussionmentioning

confidence: 99%

Closure of Petersen's defect in gastrectomy for gastric cancer: an interrupted time-series analysis from a high-volume institution in China

Wang

Chen

et al. 2020

Preprint

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Background Internal hernia (IH) and small bowel obstruction (SBO) are serious complications after gastrectomy for gastric cancer. Whether closure of Petersen's defect (PD) might reduce the rates is unknown. Methods Patients underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without closure of PD (non-closure group). From February 2017 to June 2018, we closed PD (closure group). The rates of IH, suspected internal hernia (SIH), and SBO were compared between the two groups. Results Among a total of 1213 patients, 151 patients (12.4%) developed SBO after gastrectomy, 10 patients (0.8%) developed IH and 20 patients (1.6%) developed SIH. The rate of SBO and SIH were 15.0% (124/828) and 2.3% (19/828) respectively in the non-closure group, compared with 7.0% (27/385) and 0.3% (1/385) in the closure group (p = 0.017 and p = 0.015 respectively). The rate of IH in the closure group (1/385, 0.3%) was lower than the non-closure group (9/828, 1.1%). Non-closure of PD was a risk factor for IH and SIH [odds ratio (OR) 6.58, 95%CI 1.56–27.85, p = 0.011]. Conclusions Closure of PD is recommended after gastrectomy, as we noticed a significantly lower rate of SBO and SIH, and a tendency for lower rate of IH.

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Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer

Cited by 9 publications

References 26 publications

Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

Closure of Petersen’s defect in gastrectomy for gastric cancer: an interrupted time series analysis from a high-volume institution in China

Closure of Petersen's defect in gastrectomy for gastric cancer: an interrupted time-series analysis from a high-volume institution in China

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